Intracranial Sinus Thrombosis Research Articles

Benign intracranial hypertension associated to blood coagulation derangements

BackgroundBenign Intracranial Hypertension (BIH) may be caused, at least in part, by intracranial sinus thrombosis. Thrombosis is normally due to derangements in blood coagulation cascade which may predispose to abnormal clotting activation or deficiency in natural inhibitors' control. The aim of the study is to examine the strength of the association between risk factors for thrombosis and BIH.Patients and methodsThe incidence of prothrombotic abnormalities among a randomly investigated cohort of 17 patients with BIH, was compared with 51 healthy subjects matched for sex, age, body mass index, height and social background.ResultsThe number of subjects with protein C deficiency was significantly higher in patients than in controls (3 vs 1, p < .001; Fisher Exact Test). Moderate to high titers of anticardiolipin antibodies (β2-Glycoprotein type I) were found in 8 out of 17 patients.Increased plasma levels of prothrombin fragment 1+2, fibrinopeptide A (FPA), and PAI-1 were demonstrated in patients group (5.7 ± 1.15 nM vs 0.45 ± 0.35 nM; 8.7 ± 2.5 ng/mL vs 2.2 ± 1.25 ng/mL; 45.7 ± 12.5 ng/mL vs 8.5 ± 6.7 ng/mL, respectively; p < .001; Fisher Exact Test). Gene polymorphisms for factor V Leiden mutation, prothrombin mutation 20210 A/G, MTHFR 677 C/T, PAI-1 4G/5G, ACE I/D were detected in 13 patients.DiscussionIn agreement with other authors our data suggest a state of hypercoagulability in BIH associated with gene polymorphisms. Our findings also showed that mutations in cardiovascular genes significantly discriminate subjects with a BIH history. The association between coagulation and gene derangements, usually regarded to as cryptogenic, may suggest a possible pathogenetic mechanism in BIH. So, a prothrombotic tendency may exist that would, at least in part, explain some cases of BIH.Although based on a small population, these findings raise the exciting possibility of using these haemostatic factors as markers for selecting high-risk subjects in BIH disease.

Otogenic intracranial complications: A review of 28 cases

Conclusions. Antibiotic treatment does not absolutely prevent the development of otogenic intracranial complications (ICC); however, their incidence is relatively low (0.36%).Various pathogens can be isolated in cultures of patients with these complications, but combinations of third- or fourth-generation cephalosporins with chloramphenicol, vancomycin, metronidazole or aminoglycosides can provide good results. Underlying cholesteatoma is common and is usually associated with intracranial abscess or sinus thrombosis. High morbidity rates warrant long-term follow-up. Objective. To evaluate the cause and nature of otogenic ICC in patients treated at 1 medical center over an 18-year period. Material and methods. This was a retrospective chart review of 28 patients admitted to Sheba Medical Center, Israel with otogenic ICC between 1984 and 2002. Results. Meningitis was the commonest complication (46.4%), followed by brain abscess, epidural abscess, sigmoid sinus thrombosis, subdural empyema, perisinus abscess and transverse and cavernous sinus thrombosis. Twelve patients (42.9%) had received antibiotic treatment prior to admission. Chronic otitis media, cholesteatoma and brain abscess were diagnosed mainly in adults, while acute otitis media and epidural abscess were more frequent in children. Twenty-one patients underwent mastoidectomy to eradicate the source of infection. The commonest finding at surgery was granulations (81%). Cholesteatoma was seen in 38.1% of cases. Cholesteatoma and brain abscess were usually associated with Gram-negative bacterial infection. Meningitis, however, was caused by Streptococcus pneumoniae in 40% of cases. CT showed a sensitivity of 92.75% for diagnosing otogenic ICC. There was no mortality. The morbidity rate was high (71.4%) and included hearing impairment, hemiparesis, hydrocephalus, mental retardation, polyneuropathy and epilepsy.

Cerebral sinus thrombosis in patients with inflammatory bowel disease: A case report

Inflammatory bowel disease (IBD) is an idiopathic inflammatory disease of the gastrointestinal tract. The pathophysiology of IBD is probably the result of the complex interaction of genetic susceptibility and environmental influences. There is a well-known risk of thrombosis in patients with IBD. We present the case of a 53-year-old man with ulcerative colitis, who spontaneously developed intracranial sinus thrombosis that was treated with low molecular weight heparin. Literature was searched to assess the frequency and characteristics of cerebral sinus thrombosis in IBD and the role of certain etiopathological factors in such thrombotic patients.

Sepsis und Multiorganversagen nach BCG-Instillation bei Blasenkarzinom

Local Bacillus Calmette-Guerin (BCG) immunotherapy is an effective and widely used treatment for superficial bladder carcino-ma. Local side effects are frequent, where-as systemic side effects are rare, but more serious. Systemic BCG infection as a life-threatening complication of intravesical BCG instillation should be suspected in any patient who presents with persistent fever after BCG instillation for bladder cancer.A 62-year-old patient had been treated with 6 intravesical BCG instillations for recurrent, multifocal bladder carcinoma.4 weeks after the last instillation, he presented with fever, malaise and scleral icterus. Laboratory tests revealed abnormal li-ver function tests, panzytopenia and signs of coagulation disorder. Bone marrow biopsy and liver biopsy showed non-caseating granulomas. Systemic BCG infection was suspected and antituberculous therapy combined with steroids was started. The patient developed severe sepsis and suffered from multiple organ failure. Despite partial improvement, the course was complicated by intracranial sinus thrombosis, and the patient died two month after admission.

Thunderclap Headache: Presentation of Intracranial Sinus Thrombosis?

Intracranial sinus thrombosis (ICST) and subarachnoid haemorrhage (SAH) are common presentations to neuroscience departments, which may indicate potentially life-threatening neurological conditions, however the two disorders require completely different treatment. Non-thrombotic SAH is most frequently the result of ruptured berry aneurysm and often presents with a sudden onset of severe headache. ICST may uncommonly present with thunderclap headache, that is, sudden onset severe headache, thereby mimicking SAH. The classic computed tomography (CT) appearances of SAH and ICST are different and not usually a source of diagnostic mistakes. However, errors can occur and in this paper, we present three cases of ICST that were misdiagnosed as SAH on the clinical presentation and on the initial CT brain examinations.

Sigmoid Sinus Thrombosis After Mild Closed Head Iniury in an Infant. Diagnosis by Magnetic Resonance Imaging in the Acute Phase. Case Report.

Intracranial sinus thrombosis following a mild closed head injury without a skull fracture or intracranial hematoma is extremely rare. A 23-month-old girl presented with vomiting and gait ataxia 1 day after occipital trauma. Computed tomography revealed a slightly increased density area in the region of the left sigmoid sinus. T1-weighted magnetic resonance (MR) imaging demonstrated an isointense area in the left sigmoid sinus and T2-weighted imaging showed a hyperintense area reflecting the characteristics of oxyhemoglobin. MR angiography and cerebral angiography indicated occlusion of the left sigmoid sinus. After 4 days of conservative treatment, her symptoms subsided completely. Follow-up MR angiography and cerebral angiography showed recanalization of the sigmoid sinus. The MR images and MR angiograms were useful for both early diagnosis and follow-up. Treatment should reflect the severity of individual cases, and early diagnosis will help achieve a good outcome.

Intracranial Angioplasty and Thrombolysis

With careful patient selection, timely neuroendovascular therapy can improve the clinical outcome of patients suffering from cerebrovascular ischemic disease. The current indications, techniques, recent experiences, limitations, and future directions of balloon angioplasty and local intra-arterial/intravenous thrombolysis in the treatment of intracranial vasospasm, atherosclerotic disease, thromboembolism, and dural sinus thrombosis are reviewed.

Direct Endovascular Thrombolytic Therapy for Dural Sinus Thrombosis

PURPOSE To evaluate the efficacy, safety, and results of direct thrombolytic therapy in intracranial dural sinus thrombosis by infusion of alteplase (recombinant tissue plasminogen activator). METHODS Nine patients were treated during a 2-year period for intracranial dural sinus thrombosis. A microcatheter was placed directly into the thrombus in the dural sinus via the transfemoral route. Thrombolysis was initiated with a rapid injection of 10 mg of alteplase over 10 minutes, followed in 3 hours by a continuous infusion of 50 mg, then a continuous infusion at 5 mg per hour until complete thrombolysis or a total dose of 100 mg per day had been reached. Repeat thrombolysis was tried the following day if complete recanalization did not occur at 100 mg per day. RESULTS Successful recanalization with improvement of symptoms was achieved in all cases. Time required for complete thrombolysis was between 8 and 43 hours. The total dose of alteplase ranged from 50 to 300 mg. Complications of a small intrapelvic hemorrhage and oozing at a femoral puncture site occurred in separate cases, but were not related to the amount of infused alteplase. MR venograms obtained 1 to 4 weeks after the procedure showed no evidence of reocclusion of the dural sinuses. CONCLUSION Direct fibrinolytic therapy with alteplase is safe, fast, and effective in treating dural sinus thrombosis. However, to prevent hemorrhagic complications, further studies are required to determine its optimal dose and proper rate of administration.

Intracranial dural sinus thrombosis following intrauterine instillation of hypertonic saline

Intracranial dural sinus thrombosis following intrauterine instillation of hypertonic saline